Licence: Public Domain Mark
Credit: Mental diseases / by Charles F. Folsom. Source: Wellcome Collection.
Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.
104/122 page 192
![The ])atient may recall many long-past events fiiirly well when lie cannot ilud his way to the dinner-table without blundering, when he does not know morning from afternoon, and after he is unable to dress and undress himself without constant remindings or even actual help. Such paralytics wander off and die of exposure, are picked up by the police as having lost their way or as not knowing where tlieir home is, or fall into some fatal danger from Avhich they have not mind enough to extricate themselves. When the mental impairment has reached this point the lack of mind shows itself in a lack of facial expression, which is so cha- racteristic of the disease that with a practised eye it is recognized as far as the countenance can be distinctly seen; and from this point the prog- ress is commonly quite rapid to absolute dementia, entire inability to form or express thoughts, too little intellect to even attend to the daily natural wants, and a descent to the lowest possible plane of vegetative life, and then death. At some time or other in the history of general paralysis delusions of grandeur, a general feeling of personal expansiveness or extreme self-satis- faction, may be confidently looked for. In the melancholic and hypochon- driacal forms of the disease, as has already been mentioned, they are late symptoms; in the demented type they occur only, for the most part, near tiie final stage of absolute dementia; and in the excited form they are usually found from the beginning or at least developing from a general feeling of bien-etre. They may vary from what would pass as inordinate, silly conceit to a wildness of delirium which stops hardly short of infinity. The patient is the greatest financier, the handsomest man, the best runner, can out-box the champion pugilist, can write the finest sermons. Delu- sions of this degree, especially in women, are apt to refer to the repro- ductive faculty or to the qualities which please the opposite sex. One man can make a million dollars a day writing poetry; another is building cities of solid gold; another owns all the railroads in the country, is king over all the earth, god over God ; another is running express-trains over his bridge across the Atlantic or has a doctor Avho comes to see him in a balloon. There is often a depth of vulgarity and obscenity about the delusions which is rarely seen in other diseases. When the grand delu- sions appear in the melancholic form, they are apt to be tinged with gloom, as of a queen whose diamonds are withheld from her, a lover who is kept from his princess bride, etc. In the hypochondriacal form it may be a crystal liver, a silver stomach, a brain of solid gold, etc. Delusions of personal belittlemeut, called micromania, sometimes follow or alternate with the megalomania. Maniacal excitement is a late symptom in the demented, hypochondri- acal, and melan(!holic forms of general paralysis; and it rarely occurs in them except in the final months of the disease, unless as a direct sequence of congestive, epileptiform, or apoplectiform attacks, and then it lasts usuallv from a few hours to several days. These attacks may occur at any time without any warning whatever, and may be attended with fury or stu])or also. As a matter of fact, they are very rare at an early stage except in the excited form of general paralysis, of which they are a pretty constant symjitom until marked dementia has appeared, and they may con- tinue to the end. The fury of these maniacal attacks is of the most furi- ous and maddest kind, blind, the most utterly regardless of consequences](https://iiif.wellcomecollection.org/image/b2119760x_0104.jp2/full/800%2C/0/default.jpg)
